摘要:

ObjectiveTo evaluate whether the availability of highly active antiretroviral therapy (HAART) has motivated people at risk for HIV infection to be tested earlier.MethodsData are from the Adult and Adolescent Spectrum of HIV Disease (ASD) Study, a chart review study of HIV-infected people receiving care. The sample comprised newly diagnosed HIV-positive persons initiating care at five ASD clinics in New York City (NYC) 1994 to 1999. CD4+lymphocyte count and clinical status (asymptomatic, major AIDS-related symptoms, AIDS-defining opportunistic illnesses) at first visit were ascertained. Trends in these two outcomes were analyzed comparing each time period after the second half of 1996 with the aggregate period from 1994 to the first half of 1996.ResultsBetween 1994 and 1999, we identified 545 patients newly diagnosed as positive for HIV with a first visit to an ASD clinic. Patients were predominantly black or Hispanic (93%). The mean CD4+count at baseline was 246 cells/&\macr;&mgr;l and the median was 152 cells/&\macr;&mgr;l. After adjusting for covariates, the mean CD4+count of newly diagnosed HIV-positive patients was significantly lower (p= .04) only during the second half of 1997. The proportion of patients who were asymptomatic at baseline ranged from 29% in the second half of 1998 to 61% in the first half of 1994 (&khgr;2= 48.8;p=.0008). After adjustment for covariates, the probability of a patient having a major symptom or an opportunistic illness at baseline was significantly higher only during the second half of 1998 (p= .001).DiscussionDuring most time periods, both before and after the introduction of HAART, most newly diagnosed patients at these five HIV clinics in NYC were immune suppressed and symptomatic.

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo analyze the cost-effectiveness of New York State–approved syringe exchange programs (SEPs) and estimate the cost-saving potential of these programs.Design and MethodsThe cost-effectiveness analysis used cost and process data provided by seven SEPs for the calendar year 1996 or the most recent 12-month period available at the time of the study. Alternative estimates of the number of HIV infections prevented were calculated using published data and a simplified circulation model. HIV treatment costs were taken from the literature.ResultsA cost-effectiveness ratio of $20,947 per HIV infection averted was calculated based on an estimated 87 HIV infections averted across the seven programs and total program costs of $1.82 million (all amounts given in US dollars). Sensitivity analyses were also performed. Using imputed costs for donated services and estimates of lifetime costs to treat an HIV infection, syringe exchange was demonstrated to be a cost-saving strategy from a societal perspective.ConclusionsThis research demonstrates that syringe exchange is a cost-effective and cost-saving strategy for reducing HIV transmission.

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe intent of this study was to identify opportunities for improving the effectiveness of HIV prevention before nonurban (rural and small-city resident) Southern women are infected and the medical and social services offered to them after they are infected.MethodsAt several HIV clinics in nonurban Alabama and Mississippi, women with HIV infection (who reside in small cities and towns outside of Birmingham) were identified and interviewed about the period during which they probably acquired HIV and about their needs and the services provided after they were found to be infected with HIV.ResultsBefore they were infected, these 211 young (mean age, 33 years), mainly African-American (67%) women often reported being seen at HIV testing sites (37%) and, among drug users, at drug treatment facilities (30%), where they presumably received counseling to prevent becoming infected. Once infected, many (21%) said they were not directed to HIV treatment sites, half (50%) were sexually active in the month before they were interviewed, many (13%) sought treatment of sexually transmitted diseases in the 12 months before the interview, and many (36%) reported unmet needs for HIV treatment related to having no insurance or Medicaid.ConclusionsPrevention and treatment of HIV for nonurban Southern women are not fully effective. Given the continued sexual activity of these women, more focus on preventing transmission from persons who are already infected is warranted.

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo assess the association between proximity to a needle exchange program (NEP) and experience of violence in an inner city neighborhood.MethodsA cross-sectional survey of residents of Harlem, New York City provided data for this study. We used geocoding to obtain the distance between respondents and the nearest NEP. Respondents reported violence they were aware of or had personally experienced in their neighborhood. Multiple logistic regression analyses assessed the relation between violence and distance from the nearest NEP.ResultsAmong 220 respondents, 50.1% were African American, 39.0% were Latino, 44.7% were male, and the mean age was 44.5 years. In separate age-, race-, sex-, and income-adjusted logistic regression models, there was no significant association between (1) reporting a fight and distance from the nearest NEP (odds ratio [OR] = 1.05,p= .89); (2) robbery in the neighborhood in the previous 6 months and distance from the nearest NEP (OR = 1.13,p= .71); (3) ever having experienced violence and distance from the nearest NEP (OR = 0.72,p= .52); or (4) ever having been robbed by drug users and distance from the nearest NEP (OR = 1.05,p= .91).ConclusionsThere was no consistent association between living close to NEPs and violence reported by residents of Harlem in this study. This study suggests that NEPs do not adversely affect rates of violence in their vicinity.

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

We examined sociodemographic, behavioral, and clinical characteristics associated with inconsistent condom use in a cross-sectional analysis of 145 sexually active HIV-serodiscordant heterosexual couples who participated in the California Partners Study II. All couples were aware of their HIV-serodiscordant status. Forty-five percent of couples reported having had unprotected vaginal or anal sex in the previous 6 months. In the multivariate couple-level analyses, factors independently associated with inconsistent (i.e., <100%) condom use in the previous 6 months included lower educational level, unemployment, African-American ethnicity, and practice of anal sex by the couple. Injection drug use was associated with inconsistent condom use among couples with younger HIV-infected partners. In addition, couples with HIV-infected partners who had higher CD4 cell counts and couples in which the HIV-infected male partner ever had sex with a man were more likely to use condoms inconsistently. Consistency of condom use did not depend on the gender of the HIV-infected partner or duration of sexual relationship. The findings suggest that many HIV-serodiscordant heterosexual couples remain at high risk of HIV transmission and may benefit not only from behavioral interventions but also from structural interventions aimed at improving their social and economic conditions.

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundSantos Metropolitan Region (SMR), State of Sao Paulo, historically is well known as being one of the areas with the largest number of AIDS cases in Brazil, especially among injection drug users (IDUs). The main objective of this study was to assess the effects of changes in drug-using patterns among IDUs on trends in HIV infection among IDUs in the 1990s.MethodsDuring 1991 through 1992 (wave 1;n= 214), 1994 through 1996 (wave 2;n= 135), and 1999 (wave 3;n= 108), we conducted three cross-sectional studies of IDUs. All participants were interviewed and tested for antibodies to HIV.FindingsThe overall sample population was 69% male, and 87% of the sample population was under 40 years old. Eighty-four percent of the population had less than 9 years of education. HIV seroprevalence was 63% in wave 1, 65% in wave 2, and 42% in wave 3 (p< .001). Smoking of crack cocaine increased from 11% in wave 1 to 60% in wave 2 and 67% in wave 3 (p< .001). The prevalence of frequent injections (>5 per day) decreased from 42% in wave 1 to 30% in wave 2 and 15% in wave 3 (p< .001).InterpretationHIV prevalence decreased as injection frequency decreased and crack cocaine use increased. In SMR, patterns of drug use have been affecting the HIV epidemic more than scant public health intervention.

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID